IS OUR HEALTH FALLING APART?

We're smoking more, getting fatter and worse off than 35 states. Now there's a call for action.

Dec. 6, 2011

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Report highlights

Here are strengths and challenges highlighted in the 2010 America’s Health Rankings for our states. OHIO

Strengths: High immunization coverage, low occupational fatalities rate and moderate rate of high school graduation. Challenges: High prevalence of smoking and air pollution, along with low per capita public health funding. KENTUCKY

Strengths: Low prevalence of binge drinking and low violent crime rate. Challenges: High prevalence of smoking and obesity, along with high rates of cancer deaths and preventable hospitalizations. INDIANA

Strengths: Moderate prevalence of binge drinking and little geographic difference in health patterns across the state. Challenges: High prevalence of smoking, high percentage of children in poverty, low per capita public health funding and high levels of air pollution.

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More adult Ohioans are smoking, despite years of warnings by health officials and the state’s indoor smoking ban. The state saw the biggest percentage-point increase in smoking in 2011, a new national study out today shows.

Roughly 2.6 million, or 22.5 percent, of the state’s adults smoked in 2011, up 2.2 points in a year.

The rise occurred despite the cost of smoking in a period of weak economic growth where incomes were flat.

Nationally, 12 states posted increases in smoking, 38 (including the District of Columbia) had decreases and 1 saw no change.

Dr. Theodore Wymyslo, director of the Ohio Department of Health, didn’t have access to the complete survey Monday. But he speculated the increase was due to “the stress that people are in,” including unemployment and low self-esteem. The Ohio General Assembly also cut funding for the state’s smoking cessation help line this year; the line is still open, albeit with reduced hours.

The Buckeye State ranked as the 36th healthiest state for 2011 in the latest America’s Health Rankings. Ohio dropped three places from 33rd in 2010, apparently because of the increase in smoking.

The study “is a call for action” in many health areas such as curbing air pollution and keeping the smoking ban – now under court challenge for its constitutionality – in place, he said. “It tells us we have a ways to go.”

Meanwhile, Kentucky continued to rank among the 10 least healthy states at 43rd, the survey showed. Indiana was 38th, unchanged from 2010.

The rankings have been compiled for 22 years by the American Public Health Association, the UnitedHealth Foundation and the Partnership for Prevention.

They’re based on 15 predictive factors such as air pollution and lack of health insurance that indicate future health problems, as well as eight outcome factors such as cancer deaths and premature mortality that result from environment problems, risky behaviors and a lack of clinical care. Some of the measures are based on data from 2010, while others go back to 2006.

Vermont once again ranked as the healthiest state, while Mississippi again was the least healthy.

In addition to high rates of smoking in Ohio, Kentucky and Indiana, obesity is a problem in all three states. Obesity rates have risen by 40 percent in each of them over the past 10 years. Nearly 30 percent of all adults in each state are obese, the study found.

As obesity has become more common, so have health problems associated with it – particularly diabetes. Each state has seen the number of adults with diabetes increase by at least 60 percent since 2001. One of every 10 adults in Kentucky and Ohio are diabetics, with Indiana not far behind.

The study also shows racial and ethnic minorities in all three states are more likely to be obese and have diabetes.

For example, 28.7 percent of whites in Ohio are obese, compared to 40.8 percent of blacks and 32.5 percent of Hispanics.

Wymyslo and his counterpart in Kentucky said the study results underscore how innovation is needed to bring a more preventative approach to medicine in both states, rather than “fixing” health problems through procedures such as dialysis or heart surgery once they occur.

The bigger picture from the study is the increase of chronic disease earlier in life, Wymyslo said. But chronic diseases carry a heavy economic and emotional burden for people and society through health care costs, reduced productivity for employers and less happiness for individuals.

Dr. Steve Davis, acting commissioner of the Kentucky Department of Public Health, worries the toll from the growing wave of chronic disease will increase as the baby boomer generation continues to age “and hits the wall with heart disease, diabetes and lung disease.”

Both departments are moving toward creating “health homes” for people receiving Medicaid, the health insurance program for the poor, to improve outcomes and hold costs in check.

Ohio is moving aggressively to this model, already adopted by Minnesota and other states, while Kentucky is using it in some pilot projects.

For example, the smoking rate among Ohio’s Medicaid population is 36 percent, Wymyslo said.

“There are people who are the second or third generation on Medicaid that have been in unhealthy environments their whole lives,” he said.

“If everyone around you is smoking, who do you reach out to? These people need support and help from health care professional and others,” Wymyslo said.

Wymyslo and Davis pointed out that the United States spends more than any other nation – an estimated 17 percent of its annual gross domestic product – on health care.

“If money were the solution, we’d have the problem fixed,” Wymyslo said.